Peter Edwards is a partner at Capsticks and has 30 years’ experience of advising healthcare organisations on governance, legal powers and decision-making. He will be speaking in NAPC’s Primary Care Zone at Confed19 and available at drop-in clinics.
Since the formation of primary care networks (PCNs) was announced earlier this year, we have been working closely with a number of emerging networks to help them prepare for “go live” on 1st July. As a result, we have gained insight into some of the frequently asked questions that are being raised as networks grapple with the complexities of the template network agreement and its schedules, and some of the areas where further clarification and policy development might be useful.
Generally speaking, the networks we have worked with did not find it difficult to agree their membership and boundaries. However, this required some flexibility around the prescribed 30-50,000 population to accommodate some larger practices, or remote localities that have fewer than 30,000 patients but an established track record of working together. Some PCNs are already looking ahead to further consolidation, and the possibility of operating across a whole city or rural area.
Clinical directors (CDs) have been appointed, but there is variation in the way in which the role is remunerated with some PCNs designating the role as a new post while most will use the available funding to backfill for the time that the CD needs to discharge network duties. There has also been some variation in the detail of how CD responsibilities will be discharged within the network. In some instances, this will be by way of job sharing or allocation of some tasks to deputies.
There have been a variety of responses to the invitation to develop the template agreement schedules to reflect the particular arrangements in each network. Some PCNs have fully-documented schedules describing their governance, financial arrangements and workforce models, while others are still looking at blank sheets of paper. It’s important for PCNs to remember that the network agreement is a binding legal document, and so some attention to the detail of how your network will operate is needed. We have encouraged PCNs to focus on the issues that will be relevant from day one, such as who will employ network staff, how decisions will be made and how risks will be shared across the network. Further work on the other parts of the schedules can be carried out after 1st July.
Some of the difficult matters that have arisen in our discussions include how networks will resolve any voting “stalemates”, how the clinical director will be accountable to the network, how network funding will be allocated between practices and what is the optimal workforce model in order to avoid VAT liabilities. Not all of these can be fully resolved by the end of this month, and so we have recommended that PCNs should pencil in a review of their network agreement around the end of the financial year. By then they will have a track record of network working, and should be able to identify if any aspects of their agreement are unlikely to be fit for purpose as the network takes on more services and staff.
Overall, we have been very impressed with the energy and enthusiasm to get themselves organised that most PCNs have shown. No doubt there will be a collective sigh of relief when they are “over the line” in July but that is when the important and exciting work of improving the health of their populations begins in earnest. We look forward to continuing to work with them on this journey.